403(b) plan adoption agreementcustodial account under code 403(b)(7) annuity contract under code...

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© 2006 ASC Institute

403(b) PLAN ADOPTION AGREEMENT

SECTION 1 EMPLOYER INFORMATION

1-1 EMPLOYER INFORMATION:

Name:

Address:

City, State, Zip Code:

Telephone:

1-2 EMPLOYER IDENTIFICATION NUMBER (EIN):

1-3 TYPE OF EMPLOYER (optional): Public School State College or University Charitable organization under IRC §501(c)(3) Other:

1-4 EMPLOYER’S TAX YEAR END: The Employer’s tax year ends

1-5 RELATED EMPLOYERS: List any Related Employers (as defined in Section 1.84 of the Plan). A Related Employer must complete a Participating Employer Adoption Page for Employees of that Related Employer to participate in this Plan. The failure to cover the Employees of a Related Employer may result in a violation of the minimum coverage rules under Code §410(b).

[Note: The failure to list all Related Employers will not jeopardize the qualified status of the Plan.]

SECTION 2 PLAN INFORMATION

2-1 PLAN NAME:

2-2 TYPE OF PLAN:

Custodial Account under Code §403(b)(7)

Annuity Contract under Code §403(b)(1)

Combination Custodial Account and Annuity Contract

Other: ___________________________________________________________________________

2-3 PLAN YEAR: (a) Calendar year (b) The 12-consecutive month period ending on ___________________________ each year. (c) The Plan has a short Plan Year running from ____________ to ______________. (d) Other:

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[Plan Name] Section 3 – Eligible Employees

© 2006 ASC Institute 2/27/2007

SECTION 3 ELIGIBLE EMPLOYEES

3-1 ELIGIBLE EMPLOYEES: In addition to the Employees identified in Section 2.02 of the Plan, the following Employees are excluded from participation under the Plan with respect to the contribution source(s) identified in this AA §3-1. (See Sections 2.02(e) and (f) of the Plan for rules regarding the effect on Plan participation if an Employees changes between an eligible and ineligible class of employment.)

Deferral Match ER

(a) No exclusions.

(b) Collectively Bargained Employees.

(c) Nonresident aliens who receive no compensation from the Employer which constitutes U.S. source income.

(d) Leased Employees.

(e) Student Employees.(as defined in Section 1.95 of the Plan).

(f) Employees who normally work less than 20 hours a week.

(g) Religious staff as described in Section 2.02(c)(1) of the Plan .

(h) Highly Compensated Employees.

N/A N/A (i) Employees eligible for a Code §457(b) plan (see Section 2.02(c)(3) of the Plan).

N/A N/A (j) Employees eligible for a 401(k) or another 403(b) plan sponsored by the Employer (see Section 2.02(c)(3) of the Plan)

N/A N/A (k) Employees whose contribution would be $200 or less (see Section 2.02(c)(3) of the Plan).

(l) Other:

[Note: Unless designated otherwise under (l), any selection(s) in the Deferral column also apply to Roth Deferrals, After-Tax Contributions, and Safe Harbor Contributions; any selection(s) in the Match column also apply to QMACs; and any selection(s) in the ER column also apply to QNECs.]

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[Plan Name] Section 4 – Minimum Age and Service Requirements


SECTION 4 MINIMUM AGE AND SERVICE REQUIREMENTS

4-1 ELIGIBILITY REQUIREMENTS – MINIMUM AGE AND SERVICE: An Eligible Employee (as defined in AA §3-1) who satisfies the minimum age and service conditions under this AA §4-1 will be eligible to participate under the Plan as of his/her Entry Date (as defined in AA §4-2 below.) [Note that an Eligible Employee becomes eligible to make Salary Deferrals on such Employee’s first day of employment with the Employer. See the Plan for the application of the minimum age and service conditions to After-Tax Employee Contributions and the application of the minimum age and service conditions to Safe Harbor Contributions.]

(a) Service Requirement. An Eligible Employee must complete the following minimum service requirements to participate in the Plan.

Match ER

(1) There is no minimum service requirement for participation in the Plan.

(2) One Year of Service (as defined in Section 2.03(a) of the Plan and AA §4-3) .

(3) The completion of ________ [cannot exceed 12] consecutive full calendar months of employment during which the Employee is credited with at least ________ [cannot exceed 1,000] Hours of Service or the completion of a Year of Service. [If no minimum Hours of Service are required, insert one (1) in the second blank line.]

(4) The completion of _________ [cannot exceed 1,000] Hours of Service during an Eligibility Computation Period. [If this (4) is chosen, an Employee satisfies the service requirement immediately upon completion of the designated Hours of Service.]

(5) Two (2) Years of Service. [Full and immediate vesting must be chosen under AA §8.]

(6) Under the Elapsed Time method. See AA §4-3(c) below.

(7) Describe eligibility conditions:

[Note: Any conditions provided under (7) must be described in a manner that precludes Employer discretion, must satisfy the nondiscrimination requirements of §1.401(a)(4) of the regulations, and may not cause the Plan to violate the provisions of Code §410(a).]

(b) Minimum Age Requirement. An Eligible Employee (as defined in AA §3-1) must have attained the following age with respect to the contribution source(s) identified in this AA §4-1(b).

Match ER

(1) There is no minimum age for Plan eligibility.

(2) Age 21.

(3) Age 20½.

(4) (not later than age 21).

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4-2 ENTRY DATE: An Eligible Employee who satisfies the minimum age and service requirements in AA §4-1 shall be eligible to participate in the Plan as of his/her Entry Date. For this purpose, the Entry Date is the following date with respect to the contribution source(s) identified under this AA §4-2. [Note: If any of (b) – (g) is completed for a contribution source, also complete one of (h) – (k) for the same contribution source.]

Match ER

(a) Immediate. The date the minimum age and service requirements are satisfied (or date of hire, if no minimum age and service requirements apply).

(b) Semi-annual. The first day of the 1st and 7th month of the Plan Year.

(c) Quarterly. The first day of the 1st, 4th, 7th and 10th month of the Plan Year.

(d) Monthly. The first day of each calendar month.

(e) Payroll period. The first day of the payroll period.

(f) The first day of the Plan Year. [if this (f) is checked, see Section 2.03(b)(2) of the Plan for special rules that apply.]

(g) Describe Entry Date:

[Note: Any Entry Date designated in (g) must comply with the requirements of Code §410(a)(4) and must satisfy the nondiscrimination requirements under Treas. Reg. §1.401(a)(4). See Section 2.03(b) of the Plan.]

An Eligible Employee’s Entry Date (as defined above) is determined based on when the Employee satisfies the minimum age and service requirements in AA §4-1. For this purpose, an Employee’s Entry Date is the Entry Date:

Match ER

(h) next following satisfaction of the minimum age and service requirements.

(i) coinciding with or next following satisfaction of the minimum age and service requirements.

(j) nearest the satisfaction of the minimum age and service requirements.

(k) preceding the satisfaction of the minimum age and service requirements.

4-3 DEFAULT ELIGIBILITY RULES. In applying the minimum age and service requirements under AA §4-1 above, the following default rules apply with respect to all contribution sources under the Plan:

• Year of Service. An Employee earns a Year of Service for eligibility purposes upon completing 1,000 Hours of Service during an Eligibility Computation Period. Hours of Service are calculated based on actual hours worked during the Eligibility Computation Period. [See the Plan for the definition of Hours of Service.]

• Eligibility Computation Period. If one Year of Service is required for eligibility, the Plan will determine subsequent Eligibility Computation Periods on the basis of Plan Years (see Section 2.03(a)(2)(i) of the Plan). If more than one Years of Service is required for eligibility, the Plan will determine subsequent Eligibility Computation Periods on the basis of Anniversary Years.

• Break in Service Rules. The Nonvested Participant Break in Service rule and the One-Year Break in Service rule do NOT apply. (See Section 2.07 of the Plan.)

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To override the default eligibility rules, complete the applicable sections of this AA §4-3. If this AA §4-3 is not completed for a particular contribution source, the default eligibility rules apply.

Match ER

(a) Year of Service. Instead of 1,000 Hours of Service, an Employee earns a Year of Service upon the completion of __________ [must be less than 1,000] Hours of Service during an Eligibility Computation Period.

(b) Eligibility Computation Period (ECP). The Plan will use Anniversary Years, unless more than one Year of Service is required under AA §4-1(a), in which case the Plan will shift to Plan Years.

(c) Elapsed Time method. [Check the same contribution source as checked in AA §4-1(a)(6) above.] Eligibility service will be determined under the Elapsed Time method. An Eligible Employee (as defined in AA §3-1) must complete a ____________ [not to exceed 12] month period of service to participate in the Plan. (See Section 2.03(a)(5) of the Plan.)

(d) Equivalency Method. For purposes of determining an Employee’s Hours of Service for eligibility, the Plan will use the Equivalency Method (as defined in Section 2.03(a)(4) of the Plan). The Equivalency Method will apply to:

(1) All Employees. (2) Only Employees for whom the Employer does not maintain hourly records. For

Employees for whom the Employer maintains hourly records, eligibility will be determined based on actual hours worked.

If this (d) is checked, Hours of Service for eligibility will be determined under the following Equivalency Method.

(3) Monthly. 190 Hours of Service for each month worked. (4) Daily. 10 Hours of Service for each day worked. (5) Weekly. 45 Hours of Service for each week worked. (6) Semi-monthly. 95 Hours of Service for each semi-monthly period worked.

(e) Nonvested Participant Break in Service rule applies. Service earned prior to a Nonvested Participant Break in Service will be disregarded in applying the eligibility rules. (See Section 2.07(b) of the Plan)

(f) One-Year Break in Service rule applies. The One-Year Break in Service rule (as defined in Section 2.07(d) of the Plan) applies to temporarily disregard an Employee’s service earned prior to a one-year Break in Service.

4-4 EFFECTIVE DATE OF MINIMUM AGE AND SERVICE REQUIREMENTS. The minimum age and/or service requirements under AA §4-1 apply to all Employees under the Plan. An Employee will participate with respect to all contribution sources under the Plan as of his/her Entry Date, taking into account all service with the Employer, including service earned prior to the Effective Date.

To allow Employees hired on a specified date to enter the Plan without regard to the minimum age and/or service conditions, complete this AA §4-4.

Match ER

An Eligible Employee who is employed by the Employer on the following date will become eligible to enter the Plan on such date:

(a) the Effective Date of this Plan (as designated in subsection (a) or (b) of the Employer Signature Page, as applicable)

(b) [insert date]

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4-5 SERVICE WITH PREDECESSOR EMPLOYER. If the Employer is maintaining the Plan of a Predecessor Employer, service with such Predecessor Employer is automatically counted for eligibility, vesting and for purposes of applying any allocation conditions under AA §6-6 and AA §6B-7.

In addition, service with the following Predecessor Employers also will be counted for purposes of determining eligibility, vesting and allocation conditions under this Plan. (See Sections 2.06, 3.09 and 7.06 of the Plan.)

(a) Identify Predecessor Employer(s): (b) The following special rules apply:

[Use this (b) to impose limits on the service that will be taken into account with a Predecessor Employer for determining eligibility, vesting and allocation conditions. For example, if service with a Predecessor Employer will not be taken into account in the same manner in applying eligibility, vesting and allocation conditions, the limits applicable to such service may be identified in (b). Any limits imposed under this (b) may not cause the Plan to violate the nondiscrimination requirements under Treas. Reg. §1.401(a)(4).]

SECTION 5

COMPENSATION DEFINITIONS

5-1 TOTAL COMPENSATION. Total Compensation is based on the definition set forth under this AA §5-1. See Section 1.99 of the Plan for a specific definition of the various types of Total Compensation.

(a) W-2 Wages (b) Code §415 Compensation. (c) Wages under Code §3401(a).

[For purposes of determining Total Compensation, each definition includes Elective Deferrals, pre-tax contributions to a Code §125 cafeteria plan or a Code §457 plan, and qualified transportation fringes under Code §132(f)(4).]

5-2 PLAN COMPENSATION: Plan Compensation is Total Compensation (as defined in AA §5.1 above) with the following exclusions described below.

[Note: Unless otherwise provided under (k) above, the adjustments under (e) through (k) (other than subsection (i)) do not apply to Nonhighly Compensated Employees in determining allocations under the Safe Harbor 401(k) provisions under AA §6C. The exclusions elected under (b) through (d) also may be limited solely to Highly Compensated Employees by designating such limitation in (k).Unless designated otherwise under (k), any selection(s) in the Deferral column also apply to Roth Deferrals, After-Tax Contributions, and Safe Harbor

Deferral Match ER

(a) No exclusions.

N/A (b) Elective Deferrals (as defined in Section 1.42 of the Plan), pre-tax contributions to a cafeteria plan or a Code §457 plan, and qualified transportation fringes under Code §132(f)(4) are excluded.

(c) All fringe benefits, expense reimbursements, deferred compensation, and welfare benefits are excluded.

(d) Compensation above $ is excluded.

(e) Amounts received as a bonus are excluded.

(f) Amounts received as commissions are excluded.

(g) Overtime payments are excluded.

(h) Amounts received for services performed for a non-signatory Related Employer are excluded.

(i) ”Deemed §125 compensation” as defined in Section 1.99 of the Plan.

(j) Amounts received after termination of employment are excluded.

(k) Describe adjustments to Plan Compensation:

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[Plan Name] Section 5 – Compensation Definitions


Contributions; any selection(s) in the Match column also apply to QMACs; and any selection(s) in the ER column also apply to QNECs.]

5-3 PERIOD FOR DETERMINING COMPENSATION.

(a) Compensation Period. Plan Compensation will be determined on the basis of the following period(s) for the contribution sources identified in this AA §5-3. [If (2), (3) or (4) is checked for any contribution source, any reference to the Plan Year as it refers to Plan Compensation for that contribution source will be deemed to be a reference to the period designated below.]

Deferral Match ER

(1) The Plan Year.

(2) The calendar year ending in the Plan Year.

(3) The Employer's fiscal tax year ending in the Plan Year.

(4) The 12-month period ending on _________________________ which ends during the Plan Year.

(b) Compensation while a Participant. In determining Plan Compensation, only compensation earned while an individual is a Participant under the Plan will be taken into account for all contribution sources. To count compensation for the entire Plan Year, including compensation earned while an individual is not a Participant, check below.

Match ER

All compensation earned during the Plan Year will be taken into account, including compensation earned while an individual is not an Eligible Participant.

SECTION 6 EMPLOYER CONTRIBUTIONS

6-1 EMPLOYER CONTRIBUTIONS. Is the Employer authorized to make Employer Contributions and/or Qualified Nonelective Contributions (QNECs) under the Plan?

Yes No [If No, skip to Section 6A.]

6-2 EMPLOYER CONTRIBUTION FORMULAS: For the period designated in AA §6-5 below, the Employer will make the following Employer Contributions on behalf of Participants who satisfy the allocation conditions designated in AA §6-6 below. Any Employer Contribution authorized under this AA §6-2 will be allocated in accordance with the allocation formula selected under AA §6-3 or AA §6-4, as applicable.

(a) Discretionary contribution. The Employer will determine in its sole discretion how much, if any, it will make as an Employer Contribution.

(b) Fixed contribution. (1) % of each Participant’s Plan Compensation. (2) $ for each Participant.

(c) Service-based contribution. The Employer will make: (1) Discretionary. A discretionary contribution determined as a uniform percentage of Plan

Compensation or a uniform dollar amount for each period of service designated below. (2) Fixed percentage. _________% of Plan Compensation paid for each period of service designated

below. (3) Fixed dollar. $_________ for each period of service designated below.

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[Plan Name] Section 6 – Employer Contributions


The service-based contribution selected under this (c) will be based on the following periods of service: (4) Each Hour of Service (5) Each week of employment (6) Describe period: ________________________________________________________________

The service-based contribution selected under this (c) is subject to the following limitations: (7) Describe limitations:

(d) Qualified Nonelective Contribution (QNECs) are authorized as provided under AA §6-4 below.

(e) Describe other method for making Employer Contributions:

6-3 ALLOCATION FORMULA. (a) Pro rata allocation. The Employer Contribution under AA §6-2 will be allocated as a uniform percentage

of Plan Compensation or as a uniform dollar amount. If a fixed Employer Contribution is selected in AA §6-2(b), the Employer Contribution will be allocated in accordance with the selections made in AA §6-2. If the service-based contribution formula is selected, the Employer Contribution will be allocated in accordance with the selections made in AA §6-2(c).

(b) Other allocation method:

6-4 QUALIFIED NONELECTIVE CONTRIBUTIONS (QNECs): For any Plan Year, the Employer may make a discretionary QNEC to the Plan. Such QNEC will be allocated as a uniform percentage of Plan Compensation to all Nonhighly Compensated Participants, without regard to the allocation conditions selected in AA §6-6 below. To modify these default allocation provisions, complete the applicable provision under this AA §6-4.

(a) All Participants. Any QNEC made pursuant to this AA §6-4 will be allocated to all Participants, including Highly Compensated Participants.

(b) Targeted QNECs. The QNEC will be allocated to Nonhighly Compensated Employees in accordance with the Targeted QNEC allocation formula under Section 3.02(b)(2)(ii) of the Plan. For this purpose, a Targeted QNEC may be allocated as a percentage of Plan Compensation or as a uniform dollar amount. See Section 3.02(b)(2)(ii) of the Plan.

6-5 SPECIAL RULES. No special rules apply with respect to Employer Contributions under the Plan, except to the extent designated under this AA §6-5.

(a) Period for determining Employer Contribution. In determining the amount of the Employer Contributions to be allocated under this AA §6, the Employer Contribution will be based on Plan Compensation earned during the Plan Year.

Alternatively, the Employer may elect to base the Employer Contributions on Plan Compensation earned during the following period:

(1) Plan Year quarter. (2) calendar month.

(3) payroll period. (4) Other:

(b) Contribution Limits. Employer Contributions will be limited as follows:

6-6 ALLOCATION CONDITIONS. An Eligible Participant who has otherwise satisfied all conditions to receive an Employer Contribution, must satisfy any allocation conditions designated under this AA §6-6 to receive an allocation of Employer Contributions under the Plan. [Note: The allocation conditions under this AA §6-5 do not apply to Safe Harbor Employer Contributions.]

(a) No allocation conditions apply with respect to Employer Contributions under the Plan.

(b) Safe harbor allocation condition. An Employee must be employed by the Employer on the last day of the Plan Year OR must complete more than:

(1) ______ (not to exceed 500) Hours of Service during the Plan Year. (2) ____ (not more than 91) consecutive days of employment with the Employer during the Plan Year.

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[Plan Name] Section 6 – Employer Contributions


(c) Employment condition. An Employee must be employed with the Employer on the last day of the Plan Year.

(d) Minimum service condition. An Employee must be credited with at least: (1) Hours of Service (not to exceed 1,000) during the Plan Year. (2) ___ (not more than 182) consecutive days of employment with the Employer during the Plan Year.

(e) Exceptions. The above allocation condition(s) will not apply if the Employee: (1) dies during the Plan Year. (2) terminates employment as a result of a Disability. (3) terminates employment after attainment of Normal Retirement Age in the current Plan Year or any

prior Plan Year.

SECTION 6A SALARY DEFERRALS

6A-1 SALARY DEFERRALS. Are Employees permitted to make Salary Deferrals under the Plan?

Yes.

No. [If “No” is checked, skip to Section 6B.]

6A-2 MAXIMUM LIMIT ON SALARY DEFERRALS. A Participant may defer an amount up to the Elective Deferral Dollar Limit and the Code §415 Limitation. See Sections 5.02 and 5.03 of the Plan.

6A-3 MINIMUM DEFERRAL RATE. There is no minimum deferral rate applicable to Salary Deferrals under the Plan.

6A-4 CATCH-UP CONTRIBUTIONS. The following provisions apply with respect to Catch-Up Contributions (as defined in Section 3.03(d) of the Plan).

(a) Catch-Up Contributions are permitted under the Plan. (1) Catch-Up Contributions are eligible for any Matching Contributions under the Plan. (2) Catch-Up Contributions are not eligible for any Matching Contributions under the Plan.

(b) Catch-Up Contributions are not permitted under the Plan.

6A-5 ROTH DEFERRALS. The following provisions apply with respect to Roth Deferrals (as defined in Section 3.03(e) of the Plan).

(a) Roth Deferrals are permitted under the Plan. (1) Roth Deferrals are not eligible for any Matching Contributions under the Plan.

(2) Only Roth Deferrals are eligible for any Matching Contributions under the Plan (i.e., Pre-Tax Deferrals are not eligible for Matching Contributions).

[If neither (1) nor (2) is selected, all Salary Deferrals are eligible for Matching Contributions.]

(b) Roth Deferrals are not permitted under the Plan.

6A-6 CHANGE OR REVOCATION OF DEFERRAL ELECTION: In addition to the Participant’s Entry Date under the Plan, a Participant may change, revoke or resume a Deferral Election (on a prospective basis) as of the dates designated under the Salary Deferral Agreement or other written procedures adopted by the Plan Administrator.

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[Plan Name] Section 6A – Salary Deferrals


6A-7 AUTOMATIC DEFERRAL ELECTION. No automatic deferral election applies under Section 3.03(c) of the Plan.

To provide for an automatic deferral election, complete this AA §6A-7. Upon becoming eligible to make Salary Deferrals under the Plan (pursuant to AA §3 and AA §4), an Eligible

Participant will be deemed to have entered into a Salary Deferral Election with a

(a) % of Plan Compensation (b) $_______________ deferral election for each payroll period, unless the Eligible Participant makes a contrary Salary Reduction Election (subject to the limitations under AA §6A-2) in accordance with procedures adopted by the Plan Administrator. If elected under (c) below, the automatic deferral amount will increase each Plan Year by:

(c) % of Plan Compensation or $_______________

(d) but not in excess of % of Plan Compensation or $_______________. This automatic deferral election will apply to:

(e) all Eligible Participants.

(f) Employees who become Eligible Participants on or after the following date: .

6A-8 DEFERRAL EFFECTIVE DATE. The provisions of this AA §6A are effective as of:

(a) the Effective Date of the Plan as designated in subsection (a) or (b) of the Employer Signature Page, as applicable.

(b) _______________________ (insert date). [Note: Date may not be before Effective Date of Plan as designated subsection (a) or (b) of the Employer Signature Page, as applicable.]

(c) The following special effective date applies solely for Roth Deferrals under AA §6A-5: ________________ (date may not be before January 1, 2006). [If this (c) is not checked and Roth Deferrals are permitted under AA §6A-5 above, Roth Deferrals are effective as of January 1, 2006 (or the Effective Date applicable to Salary Deferrals under this AA §6A-9, if later).]

SECTION 6B MATCHING CONTRIBUTIONS

6B-1 MATCHING CONTRIBUTIONS. Is the Employer authorized to make Matching Contributions and/or Qualified Matching Contributions (QMACs) under the Plan?

Yes. [Check this box if Matching Contributions may be made under the Plan, including Matching Contributions that satisfy the ACP safe harbor (i.e., Matching Contributions that are made in addition to the Safe Harbor Contributions required to satisfy the ADP safe harbor under AA §6C-2(a)).]

No. [Check this box if there are no Matching Contributions or the only Matching Contributions are Safe Harbor Matching Contributions that satisfy the ADP safe harbor under AA §6C-2(a). If “No” is checked, skip to Section 6C.]

6B-2 MATCHING CONTRIBUTION FORMULAS: For the period designated in AA §6B-5 below, the Employer will make the following Matching Contribution on behalf of Participants who satisfy the allocation conditions under AA §6B-7 below. [If the Plan provides for After-Tax Contributions, see AA §6D to determine the application of the Matching Contribution formulas to After-Tax Contributions.]

(a) Discretionary match. The Employer will determine in its sole discretion how much, if any, it will make as a Matching Contribution. Such amount can be determined either as a uniform percentage of deferrals or as a flat dollar amount for each Eligible Participant.

(b) Fixed match. The Employer will make a Matching Contribution for each Participant equal to: (1) % of Salary Deferrals made for each period designated in AA §6B-5 below. (2) $ for each period designated in AA §6B-5 below.

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[Plan Name] Section 6B – Matching Contributions


(c) Tiered match. The Employer will make a Matching Contribution to all Participants based on the following tiers of Salary Deferrals.

Salary Deferrals (% of Plan Compensation or dollar amount)

Match %

(1) Salary Deferrals up to first ______ % or $___________ ________%

(2) Salary Deferrals up to next ______% or $___________ ________%



[Note: All tiers must be based on percentages or dollar amounts (but not both). If the Plan is designed to satisfy the ACP safe harbor with respect to the Matching Contributions), the rate of Matching Contribution may not increase as the rate of Salary Deferrals increase.]

(d) Discretionary tiered match. The Employer will make a discretionary Matching Contribution to all Participants based on the following tiers of Salary Deferrals. The Employer may determine the amount of Matching Contribution to be made with respect each tier of Salary Deferrals.

Salary Deferrals (% of Plan Compensation or dollar amount)

(1) Salary Deferrals up to first _____% or $____________

(2) Salary Deferrals up to next _____% or $____________

(3) Salary Deferrals up to next _____% or $____________

(4) Salary Deferrals above _____% or $____________

[Note: All tiers must be based on percentages or dollar amounts (but not both). If the Plan is designed to satisfy the ACP safe harbor with respect to the Matching Contributions under this AA §6B-2, the rate of Matching Contribution may not increase as the rate of Salary Deferrals increase.]

(e) Year of Service match. The Employer will make a Matching Contribution as a uniform percentage of Salary Deferrals to all Participants based on Years of Service with the Employer.

Years of Service Matching Percentage

(1) Up to _____ YOS ________%

(2) Up to _____ YOS ________%

(3) Up to _____ YOS ________%

(4) Up to _____ YOS ________%

For this purpose, a Year of Service is each Plan Year during which an Employee completes at least 1,000 Hours of Service. Alternatively, a Year of Service is:

[Note: Each separate rate of Matching Contribution must satisfy the nondiscrimination requirements under Treas. Reg. §1.401(a)(4)-4 as a separate benefit, right or feature.]

(f) Qualified Matching Contribution (QMACs) are authorized as provided under AA §6B-4 below.

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6B-3 LIMITS ON MATCHING CONTRIBUTIONS. In applying the Matching Contribution formula(s) selected under AA §6B-2 above, the following limits apply. (If different limits apply to different Matching Contribution formulas, use (d) below to identify the different limits).

(a) No limits apply. All Salary Deferrals are eligible for Matching Contributions.

(b) Limit on Salary Deferrals. The Matching Contribution formula(s) selected in AA §6B-2 above apply only to Salary Deferrals that do not exceed:

(1) % of Plan Compensation. (2) $ . (3) A discretionary amount determined by the Employer.

(c) Limit on Matching Contributions. The total Matching Contribution provided under the formula(s) selected in AA §6B-2 above will not exceed:

(1) ________% of Plan Compensation. (2) $____________.

(d) Additional limits. Identify additional limits that apply to Matching Contributions:

[Note: If a Matching Contribution is designed to satisfy the ACP safe harbor (as described in Section 6.04 of the Plan), (b)(1) above must be completed with no more than a 6% of Plan Compensation deferral limit. In addition, if the Matching Contribution is a discretionary formula, to satisfy the ACP safe harbor, (c)(1) above also must be completed with no more than a 4% of Plan Compensation total match limit.]

6B-4 QUALIFIED MATCHING CONTRIBUTIONS (QMACs): For any Plan Year, the Employer may make a discretionary QMAC to the Plan to correct a failed ADP or ACP Test. Such QMAC will be allocated as a uniform percentage of each Nonhighly Compensated Participant’s Salary Deferrals made during the Plan Year, without regard to any allocation conditions under AA §6B-7. (See Section 3.04(c) of the Plan.)

6B-5 PERIOD FOR DETERMINING MATCHING CONTRIBUTIONS. The Matching Contribution formula(s) selected in AA §6B-2 above (including any limitations on such amounts under AA §6B-3) are based on Salary Deferrals for the Plan Year. To apply a different period for determining the Matching Contributions and limits under AA §6B-2 and AA §6B-3, check one of (a) – (d) below.

(a) payroll period. (b) Plan Year quarter.

(c) calendar month. (d) Other:

[Note: Although Matching Contributions (and any limits on those Matching Contributions) will be determined on the basis of the period designated under this AA §6B-5, this does not require the Employer to actually make contributions or allocate contributions on the basis of such period. Matching Contributions may be contributed and allocated to Participants at any time within the contribution period permitted under Treas. Reg. §1.415-6, regardless of the period selected under this AA §6B-5.]

6B-6 ACP TESTING. (See Section 6.02 of the Plan.)

(a) ACP Testing Method. The ACP Test will be performed using the following testing method: (See Section 6.02(a)(2) of the Plan.)

(1) The Plan will use the Prior Year Method in running the ACP Test. (2) The Plan will use the Current Year Method in running the ACP Test.

[Note: If the Plan is intended to be a Safe Harbor Plan (as designated in AA §6C below), the Plan must use the Current Year Method.

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(b) Special rule for first Plan Year. If this is a new Plan, the testing method selected in subsection (a) above applies for purposes of applying the ACP Test for the first Plan Year of the Plan, unless designated otherwise under this subsection (b). If the Prior Year Testing Method applies, the ACP for the Nonhighly Compensated Group is deemed to be 3%. (See Section 6.02(a)(3) of the Plan.)

(1) Instead of the Prior Year Method selected under subsection (a)(2) above, the Plan will use the Current Year Method for the first Plan Year for which the Plan is effective.

(2) Instead of the Current Year Method selected under subsection (a)(1) above, the Plan will use the Prior Year Method for the first Plan Year for which the Plan is effective.

6B-7 ALLOCATION CONDITIONS. An Participant who has otherwise satisfied all conditions to receive a Matching Contribution, must satisfy any allocation conditions designated under this AA §6B-7 to receive an allocation of Matching Contributions under the Plan.

(a) No allocation conditions apply with respect to Matching Contributions under the Plan.

(b) Safe harbor allocation condition. An Employee must be employed by the Employer on the last day of the Plan Year OR must complete more than:

(1) ______ (not to exceed 500) Hours of Service during the Plan Year. (2) ____ (not more than 91) consecutive days of employment with the Employer during the Plan Year.

(c) Employment condition. An Employee must be employed with the Employer on the last day of the Plan Year.

(d) Minimum service condition. An Employee must be credited with at least: (1) Hours of Service (not to exceed 1,000) during the Plan Year. (2) ___ (not more than 182) consecutive days of employment with the Employer during the Plan Year.

(e) Exceptions. The above allocation condition(s) will not apply: (1) if the Employee dies during the Plan Year. (2) if the Employee terminates employment as a result of a Disability. (3) if the Employee terminates employment after attainment of Normal Retirement Age in the current

Plan Year or any prior Plan Year.

Sample Document

[Plan Name] Section 6C – Safe Harbor Contributions


SECTION 6C SAFE HARBOR CONTRIBUTIONS

6C-1 SAFE HARBOR PLAN. Is the Plan intended to be a Safe Harbor Plan? Yes No (If “No” is checked, skip to Section 6D.)

6C-2 SAFE HARBOR CONTRIBUTION. To qualify as a Safe Harbor Plan, the Employer must make a Safe Harbor Matching Contribution or Safe Harbor Employer Contribution. The Safe Harbor Contribution elected under this AA §6C-2 will be in addition to any Employer Contribution or Matching Contribution elected in AA §6 or AA §6B above.

(a) Safe Harbor Matching Contribution. (1) Safe Harbor Matching Contribution formula.

(i) Basic match: 100% of Salary Deferrals up to the first 3% of Plan Compensation, plus 50% of Salary Deferrals up to the next 2% of Plan Compensation.

(ii) Enhanced match: _______% (not less than 100%) of Salary Deferrals up to % (not less than 4% and not more than 6%) of Plan Compensation.

(iii) Tiered match: % of Salary Deferrals up to the first % of Plan Compensation,

(A) plus % of Salary Deferrals up to the next % of Plan Compensation, (B) plus % of Salary Deferrals up to the next % of Plan Compensation.

[Note: The tiered match may not provide for a greater level of match at higher levels of Salary Deferrals and the total amount of Salary Deferrals eligible for a match may not exceed 6% of Plan Compensation.]

(2) Period for determining Safe Harbor Matching Contributions. The Safe Harbor Matching Contribution formula selected in (1) above is based on Salary Deferrals for the following period:

(i) Plan Year. (ii) payroll period. (iii) Plan Year quarter. (iv) calendar month. (v) Other:

(b) Safe Harbor Employer Contribution: % (not less than 3%) of Plan Compensation.

(1) Supplemental Safe Harbor notice. Check this selection if the Employer will make the Safe Harbor Employer Contribution pursuant to a supplemental notice, as described in Section 6.04(a)(4)(ii) of the Plan. [If this (1) is checked, the Safe Harbor Employer Contribution described above will be required for a Plan Year only if the Employer provides a supplemental Safe Harbor notice (as described in Section 6.04(a)(4)(ii) of the Plan). If the Employer properly provides the Safe Harbor notice but does not provide a supplemental notice, the Employer need not provide the Safe Harbor Employer Contribution described above. In such a case, the Plan will not qualify as a Safe Harbor Plan for that Plan Year and will be subject to ACP testing, as applicable.]

(2) Other plan. Check this selection if the Safe Harbor Employer Contribution will be made under another plan maintained by the Employer and identify the plan:

6C-3 ELIGIBILITY FOR SAFE HARBOR CONTRIBUTION. The Safe Harbor Contribution selected in AA §6C-2 above will be allocated all Participants who are eligible to make Salary Deferrals under the Plan, unless designated otherwise under this AA §6-3.

(a) Instead of using the eligibility conditions applicable to Salary Deferrals under AA §4-1, the following eligibility conditions apply for Safe Harbor Contributions:

(1) One Year of Service and age 21 with semi-annual Entry Dates.

Sample Document

[Plan Name] Section 6C – Safe Harbor Contributions


(2) The eligibility conditions applicable to Matching Contributions (as selected in AA §4-1). (3) The eligibility conditions applicable to Employer Contributions (as selected in AA §4-1).

(b) Instead of being allocated to all eligible Participants, the Safe Harbor Contribution will be allocated only to: (1) Nonhighly Compensated Participants who are eligible to make Salary Deferrals under the Plan (see

AA §4-1). (2) Nonhighly Compensated Participants who are eligible to make Salary Deferrals under the Plan and

any Highly Compensated Non-Key Employees who are eligible to make Salary Deferrals under the Plan (see AA §4-1).

(c) Describe eligibility conditions applicable to Safe Harbor Contributions:

SECTION 6D AFTER-TAX CONTRIBUTIONS

6D-1 AFTER-TAX CONTRIBUTIONS. Are Employees permitted to make After-Tax Contributions under the Plan? Yes No (If “No” is checked, skip to Section 7.)

6D-2 LIMITS ON AFTER-TAX CONTRIBUTIONS. An Participant may contribute any amount as After-Tax Contributions up to the Code §415 Limitation (as defined in Section 5.03 of the Plan).

6D-3 ELIGIBILITY FOR MATCHING CONTRIBUTIONS. If the Plan provides for Matching Contributions under AA §6B or Safe Harbor Matching Contributions under AA §6C, such matching contributions will apply to After-Tax Contributions made pursuant to this AA §6D.

Sample Document

[Plan Name] Section 7 – Retirement Age


SECTION 7 RETIREMENT AGE

7-1 NORMAL RETIREMENT AGE: Normal Retirement Age under the Plan is:

(a) Age _______ (not to exceed 65).

(b) The later of (1) age (not to exceed 65) or (2) the (not to exceed 5th) anniversary of the date the Employee commenced participation in the Plan.

(c) (may not be later than the maximum age permitted under subsection (b)).

SECTION 8

VESTING AND FORFEITURES

8-1 CONTRIBUTIONS SUBJECT TO VESTING. Does the Plan provide for Employer Contributions under AA §6 or Matching Contributions under AA §6B that are subject to vesting?

Yes No (If “No” is checked, skip to Section 9. See Section 7.11(a) of the Plan for default forfeiture rules.)

8-2 VESTING SCHEDULE. The vesting schedule under the Plan is as follows for both Employer Contributions and Matching Contributions, to the extent authorized under AA §6 and AA §6B. See Section 7.02(a) of the Plan for a description of the various vesting schedules under this AA §8-2. [Note: Any Safe Harbor Employer Contributions or Safe Harbor Matching Contributions under AA §6C and any QNECs or QMACs under AA §6-4 or AA §6B-4 are always 100% vested.]

(a) Employer Contributions (see AA §6) (b) Matching Contributions (see AA §6B) (1) Full and immediate vesting. (1) Full and immediate vesting. (2) Three-year cliff vesting schedule (2) Three-year cliff vesting schedule (3) Five-year cliff vesting schedule (3) Six-year graded vesting (4) Six-year graded vesting schedule (4) Modified vesting schedule (5) Seven-year graded vesting % after 1 Year of Service (6) Modified vesting schedule % after 2 Years of Service

% after 1 Year of Service % after 3 Years of Service % after 2 Years of Service % after 4 Years of Service % after 3 Years of Service % after 5 Years of Service % after 4 Years of Service 100% after 6 Years of Service % after 5 Years of Service % after 6 Years of Service 100% after 7 Years of Service

[Note: If a modified vesting schedule is selected for Employer Contributions, the vested percentage for every Year of Service must satisfy the vesting requirements under the 7-year graded vesting schedule, unless 100% vesting occurs after no more than 5 Years of Service. If a modified vesting schedule is selected for Matching Contributions, the vested percentage for every Year of Service must satisfy the vesting requirements under the 6-year graded vesting schedule, unless 100% vesting occurs after no more than 3 Years of Service.]

Sample Document

[Plan Name] Section 8 – Vesting and Forfeitures


8-3 VESTING SERVICE. In applying the vesting schedules under this AA §8, the following service with the Employer is excluded.

(a) None, all service with the Employer counts for vesting purposes.

(b) Service before the original Effective Date of this Plan (or a Predecessor Plan) is excluded. (See Section 7.06 of the Plan for rules regarding Predecessor Service.)

(c) Service completed before the Employee's (not to exceed 18th) birthday is excluded.

[Note: See Section 7.06 of the Plan and AA §4-5 for rules regarding the crediting of service with Predecessor Employers for purposes of vesting under the Plan.]

8-4 VESTING UPON DEATH OR DISABILITY. An Employee's vesting percentage increases to 100% if, while employed with the Employer, the Employee

(a) dies

(b) terminates employment with a Disability

8-5 MODIFICATION OF DEFAULT VESTING RULES. In applying the vesting requirements under this AA §8, the following default rules apply. • Year of Service. An Employee earns a Year of Service for vesting purposes upon completing 1,000 Hours of

Service during a Vesting Computation Period. Hours of Service are calculated based on actual hours worked during the Vesting Computation Period.

• Vesting Computation Period. The Vesting Computation Period is the Plan Year. • Break in Service Rules. The Nonvested Participant Break in Service rule and One-Year Break in Service rules

do NOT apply. (See Section 7.07 of the Plan.)

To override the default vesting rules, complete the applicable sections of this AA §8-5. If this AA §8-5 is not completed, the default vesting rules apply.

ER Match

(a) Year of Service. Instead of 1,000 Hours of Service, an Employee earns a Year of Service upon the completion of __________ [must be less than 1,000] Hours of Service during a Vesting Computation Period.

(b) Vesting Computation Period (VCP). Instead of the Plan Year, the Vesting Computation Period is:

(1) The 12-month period beginning with the anniversary of the Employee’s date of hire.

(2) Describe: [Note: Any Vesting Computation Period described in (2) must be a 12-consecutive month period and must apply uniformly to all Participants.]

(c) Elapsed Time Method. Vesting service will be determined under the Elapsed Time Method. (See Section 7.03(b) of the Plan.)

Sample Document

[Plan Name] Section 8 – Vesting and Forfeitures


ER Match

(d) Equivalency Method. For purposes of determining an Employee’s Hours of Service for vesting, the Plan will use the Equivalency Method (as defined in Section 7.03(a) (2) of the Plan). The Equivalency Method will apply to:

(1) All Employees. (2) Only to Employees for whom the Employer does not maintain hourly records. For

Employees for whom the Employer maintains hourly records vesting will be determined based on actual hours worked.

If this (d) is checked, Hours of Service for vesting will be determined under the following Equivalency Method.

(3) Monthly. 90 Hours of Service for each month worked. (4) Daily. 10 Hours of Service for each day worked. (5) Weekly. 45 Hours of Service for each week worked. (6) Semi-monthly. 95 Hours of Service for each semi-monthly period.

(e) Nonvested Participant Break in Service rule applies. Service earned prior to a Nonvested Participant Break in Service will be disregarded in applying the vesting rules. (See Section 7.07(c) of the Plan).

(f) One-Year Break in Service rule applies. The One-Year Break in Service rule (as defined in Section 7.07(b) of the Plan) applies to temporarily disregard an Employee’s service earned prior to a one-year Break in Service.

(g) Special vesting provisions. No special vesting provisions apply unless designated under this subsection (g):

[Note: Any special vesting provision designated in subsection (g) must satisfy the requirements of Code §411(a) and must satisfy the nondiscrimination requirements under §1.401(a)(4) of the regulations.]

8-6 ALLOCATION OF FORFEITURES. Any forfeitures occurring during a Plan Year will be:

ER Match

(a) Reallocated as additional Employer Contributions or as additional Matching Contributions.

(b) Used to reduce Employer and/or Matching Contributions.

For purposes of this AA §8-8, forfeitures will be applied:

(c) for the Plan Year in which the forfeiture occurs.

(d) for the Plan Year following the Plan Year in which the forfeitures occur.

Prior to applying forfeitures under this AA §8-8:

(e) Forfeitures will be used to pay Plan expenses.

(f) Forfeitures will not be used to pay Plan expenses.

8-7 CASH-OUT RULES. If a terminated Participant receives a complete distribution of his/her vested Account Balance while still entitled to an additional allocation, the Cash-Out Distribution forfeiture provisions do not apply until the Participant receives a distribution of the additional amounts to be allocated. (See Section 7.10(a)(1) of the Plan.) To modify the default Cash-Out Distribution forfeiture rules, complete this AA §8-7.

The Cash-Out Distribution forfeiture provisions will apply if a terminated Participant takes a complete distribution, regardless of any additional allocations during the Plan Year.

Sample Document

[Plan Name] Section 9 – Distribution Provisions – Termination of Employment


SECTION 9 DISTRIBUTION PROVISIONS – TERMINATION OF EMPLOYMENT

9-1 AVAILABLE FORMS OF DISTRIBUTION.

Lump sum distribution. A Participant may take a distribution of his/her entire vested Account Balance in a single lump sum. The Plan Administrator may, in its discretion, permit Participants to take distributions of less than their entire vested Account Balance provided, if the Plan Administrator permits multiple distributions, all Participants are allowed to take multiple distributions upon termination of employment. In addition, the Plan Administrator may permit a Participant to take an installment distribution solely to the extent necessary to satisfy the required minimum distribution rules under Section 8 of the Plan.

Additional distribution options. To provide for additional distribution options, check the applicable distribution forms under this AA §9-1. If a lump sum distribution will not be provided under the Plan, check (c) below and indicate that no lump sum distribution is available under the Plan.

(a) Installment distributions. A Participant may take a distribution over a specified period not to exceed the life or life expectancy of the Participant (and a designated beneficiary).

(b) Annuity distributions. A Participant may elect to have the Plan Administrator use the Participant’s vested Account Balance to purchase an annuity as described in Section 8.02 of the Plan.

(c) Describe: [Note: Any distribution option described in (c) will apply uniformly to all Participants under the Plan.]

9-2 QUALIFIED JOINT AND SURVIVOR ANNUITY RULES. This Plan is not subject to the Qualified Joint and Survivor Annuity rules, except to the extent required under Section 9.01 of the Plan (e.g., if the Plan is a Transferee Plan). Upon termination of employment, a Participant may receive a distribution from the Plan, in accordance with the provisions of AA §9-3, in any form allowed under AA §9-1. (If any portion of this Plan is subject to the Qualified Joint and Survivor Annuity rules, the QJSA and QPSA provisions will automatically apply to such portion of the Plan.) To override this default provision, complete the applicable sections of this AA §9-2.

(a) Joint and Survivor Rules. Check this (a) to apply the Joint and Survivor Rules to the entire Plan. If this (a) is checked, all distributions from the Plan must satisfy the QJSA and QPSA requirements under Section 9 of the Plan, with the following modifications:

(1) No modifications. (2) Modified QJSA benefit. Instead of a 50% survivor benefit, the spouse’s survivor benefit is:

(i) 100%. (ii) 75%. (iii) 66-2/3%. (3) Modified QPSA benefit. Instead of a 50% QPSA benefit, the QPSA benefit is 100% of the

Participant’s vested Account Balance.

(b) One-year marriage rule. The one-year marriage rule does not apply unless this (b) is checked. See Section 9.04(c)(2) of the Plan.

9-3 TIMING OF DISTRIBUTIONS UPON TERMINATION OF EMPLOYMENT.

(a) Distribution of vested Account Balances exceeding $5,000. A Participant who terminates employment with a vested Account Balance exceeding $5,000 may receive a distribution of his/her vested Account Balance in any form permitted under AA §9-1 within a reasonable period following:

(1) the date the Participant terminates employment. (2) the last day of the Plan Year during which the Participant terminates employment. (3) the first Valuation Date following the Participant's termination of employment. (4) the completion of _______ Breaks in Service. (5) Describe:

[Note: Any distribution event described in (5) will apply uniformly to all Participants under the Plan.]

Sample Document

[Plan Name] Section 9 – Distribution Provisions – Termination of Employment


(b) Distribution of vested Account Balances not exceeding $5,000. A Participant who terminates employment with a vested Account Balance that does not exceed $5,000 may receive a lump sum distribution of his/her vested Account Balance within a reasonable period following:

(1) the date the Participant terminates employment. (2) the last day of the Plan Year during which the Participant terminates employment. (3) the first Valuation Date following the Participant's termination of employment. (4) Describe:

[Note: Any distribution event described in (4) will apply uniformly to all Participants under the Plan.]

9-4 SPECIAL RULES.

(a) Availability of Involuntary Cash-Out Distributions. A Participant who terminates employment with a vested Account Balance of $5,000 or less will receive an Involuntary Cash-Out Distribution, subject to the Automatic Rollover provisions under Section 8.06 of the Plan.

Alternatively, an Involuntary Cash-Out Distribution will be made to the following terminated Participants: (1) No Involuntary Cash-Out Distribution. The Plan does not provide for Involuntary Cash-Out

Distributions. A Participant must consent to any distribution from the Plan, even if the Participant’s vested Account Balance does not exceed $5,000. (See Section 14.02(b) of the Plan for special rules upon Plan termination.)

(2) Lower Involuntary Cash-Out Distribution threshold. A Participant will receive an Involuntary Cash-Out Distribution only if the Participant’s vested Account Balance is less than or equal to $_________ [cannot exceed $5,000]. (See Section 14.02(b) of the Plan for special rules upon Plan termination.)

(b) Application of Automatic Rollover rules. The Automatic Rollover rules described in Section 8.06 of the Plan do not apply to any Involuntary Cash-Out Distribution below $1,000 (to the extent available under the Plan).

To override this default provision, check this subsection (b).

Check this (b) to apply the Automatic Rollover provisions under Section 8.06 of the Plan to all Involuntary Cash-Out Distributions (including those below $1,000).

(c) Treatment of Rollover Contributions. Unless elected otherwise under this (b), Rollover Contributions will be excluded in determining whether a Participant’s vested Account Balance exceeds the Involuntary Cash-Out threshold for purposes of applying the distribution rules under this AA §9 and Section 8.04(a) of the Plan. To include Rollover Contributions for purposes of applying the Plan’s distribution rules, check below.

In determining whether a Participant’s vested Account Balance exceeds the Involuntary Cash-Out threshold, Rollover Contributions will be included.

(d) Distribution upon attainment of stated age. A Participant must consent to a distribution from the Plan at any time prior to attainment of the Participant’s Required Beginning Date. To allow for involuntary distribution upon attainment of Normal Retirement Age (or age 62, if later), check below.

A distribution from the Plan will be made to a terminated Participant without the Participant’s consent, regardless of the value of such Participant’s vested Account Balance, upon attainment of Normal Retirement Age (or age 62, if later).

Sample Document

[Plan Name] Section 10 – In-Service Distributions and Required Minimum Distributions


SECTION 10 IN-SERVICE DISTRIBUTIONS AND REQUIRED MINIMIMUM DISTRIBUTIONS

10-1 AVAILABILITY OF IN-SERVICE DISTRIBUTIONS. A Participant may withdraw all or any portion of his/her vested Account Balance, to the extent designated, upon the occurrence of the event(s) selected under this AA §10-1.

Deferral Match ER

(a) No in-service distributions are permitted.

(b) Attainment of age _______. [If age is earlier than 59½, such age is deemed to be age 59½ for Salary Deferrals (if this selection is checked under that column).]

(c) A Hardship (that satisfies the safe harbor rules under Section 8.10(d)(1) of the Plan). [Note: Not applicable to QNECs, QMACs, or Safe Harbor Contributions.]

(d) Attainment of Normal Retirement Age. [If Normal Retirement Age is earlier than age 59½, such age is deemed to be age 59½ for Salary Deferrals.}

N/A (e) Describe:

[Note: Unless designated otherwise under (i), any selection(s) in the Deferral column also apply to Roth Contributions, After-Tax Contributions, Safe Harbor Contributions, QMACs and QNECs.]

10-2 SPECIAL DISTRIBUTION RULES. No special distribution rules apply, unless specifically provided under this AA §10-2.

(a) In-service distributions will only be permitted if the Participant is 100% vested in the amounts being withdrawn.

(b) A Participant may take no more than in-service distribution(s) in a Plan Year.

(c) A Participant may not take an in-service distribution of less than $___________ (may not exceed $1,000).

(d) If a Hardship distribution is permitted in AA §10-1 above, a Participant may take such a Hardship distribution after termination of employment.

(e) In-service distributions may not be made from the following Accounts: _________________________

(f) Describe: [Note: Any special rules described in (e) will apply uniformly to all Participants under the Plan.]

10-3 REQUIRED BEGINNING DATE – NON-5% OWNERS. In applying the required minimum distribution rules under Section 8.12 of the Plan, the Required Beginning Date for non-5% owners is:

(a) the later of attainment of age 70½ or termination of employment.

(b) the date the Employee attains age 70½, even if the Employee is still employed with the Employer.

Sample Document

[Plan Name] Section 11 – Miscellaneous Provisions


SECTION 11 MISCELLANEOUS PROVISIONS

11-1 VALUATION DATES. The Plan is valued annually, as of the last day of the Plan Year. In addition, the Plan will be valued on the following dates:

Deferral Match ER

(a) Daily. The Plan is valued at the end of each business day during which the New York Stock Exchange is open.

(b) Monthly. The Plan is valued at the end of each month of the Plan Year.

(c) Quarterly. The Plan is valued at the end of each Plan Year quarter.

(d) Describe: [Note: The Employer may elect operationally to perform interim valuations, provided such valuations do not result in discrimination in favor of Highly Compensated Employees.]

11-2 DEFINITION OF HIGHLY COMPENSATED EMPLOYEE. In determining which Employees are Highly Compensated (as defined in Section 1.52 of the Plan), the following rules apply:

(a) The Top-Paid Group Test does not apply.

(b) The Top-Paid Group Test applies.

(c) The Calendar Year Election applies. [This (c) may be chosen only if the Plan Year is not the calendar year. If this (c) is not selected, the determination of Highly Compensated Employees is based on the Plan Year. See Section 1.52(d) of the Plan.]

11-3 SPECIAL RULES FOR APPLYING THE CODE §415 LIMITATION. The provisions under Section 5.03 of the Plan apply for purposes of determining the Code §415 Limitation. Complete this AA §11-3 to override the default provisions that apply in determining the Code §415 Limitation under Section 5.03 of the Plan.

(a) Limitation Year. Instead of the Plan Year, the Limitation Year is the 12-month period ending ________ ___________________________.

[Note: If the Plan has a short Plan Year for the first year of establishment, the Limitation Year is deemed to be the 12-month period ending on the last day of the short Plan Year, unless provided otherwise in (c) below.]

(b) Imputed compensation. For purposes of applying the Code §415 Limitation, Total Compensation includes imputed compensation for a Nonhighly Compensated Participant who terminates employment on account of becoming Disabled. (See Section 5.03(c)(7)(iii) of the Plan.)

(c) Special rules. Instead of the default provisions under Section 5.03 of the Plan, the following rules apply:

11-4 SPECIAL RULES FOR MORE THAN ONE PLAN. If the Employer maintains another Defined Contribution Plan in which any Participant is a participant, the rules set forth under Section 5.03(b)(5) of the Plan apply. To modify the default provisions under Section 5.03(b)(5) of the Plan, designate how such rules will apply.

Instead of applying the default rules under Section 5.03(b)(5) of the Plan, the Employer will limit Annual Additions in the following manner:

Sample Document

[Plan Name] Employer Signature Page


EMPLOYER SIGNATURE PAGE

PURPOSE OF EXECUTION. This Signature Page is being executed to effect:

(a) The adoption of a new plan, effective ___________________________________ [insert Effective Date of Plan].

(b) The restatement of an existing plan, effective _____________________________ [insert Effective Date of Plan].

(1) Name of Plan(s) being restated: ______________________________________________________________.

(2) The original effective date of the plan(s) being restated:

(c) An amendment of the Plan. If this Plan is being amended, the updated pages of the Adoption Agreement may be substituted for the original pages in the Adoption Agreement. All prior Signature Pages should be retained as part of this Adoption Agreement.

(1) Identify the page(s) being replaced:

(2) Effective Date(s) of such changes:

(d) To identify a Successor Employer. Check this selection if a successor to the signatory Employer is continuing this Plan as a Successor Employer. Complete this Signature Page and substitute a new page 1 under this Adoption Agreement to identify the Successor Employer. All prior Signature Pages should be retained as part of this Adoption Agreement.

(1) Effective Date of the amendment is:

[Note: It is recommended that the Employer consult with legal counsel before executing this Agreement.] (Name of Employer) (Name of authorized representative) (Title) (Signature) (Date)

Sample Document

[Plan Name] Custodian/Insurance Company Declaration


CUSTODIAN/INSURANCE COMPANY DECLARATION

Effective date of Declaration:

Custodian/Insurance Company Signature. By signing this Declaration, the Custodian/Insurance Company agrees to the duties, responsibilities and liabilities imposed on the Custodian/Insurance Company by the BPD and this Agreement.

(Print name)

(Signature of authorized representative) (Date)

(Print name)

(Signature of authorized representative) (Date)

Sample Document

[Plan Name] Participating Employer Adoption Page

© 2006 ASC Institute Page PE-1

PARTICIPATING EMPLOYER ADOPTION PAGE

Check this selection and complete this page if a Participating Employer (other than the Employer that signs the Signature Page above) will participate under this Plan as a Participating Employer. [Note: See Section 16 of the Plan for rules relating to the adoption of the Plan by a Participating Employer. If there is more than one Participating Employer, each one should execute a separate Participating Employer Adoption Page. Any reference to the “Employer” in this Adoption Agreement is also a reference to the Participating Employer, unless otherwise noted.]

PARTICIPATING EMPLOYER INFORMATION:

Name:

Address:

City, State, Zip Code:

EMPLOYER IDENTIFICATION NUMBER (EIN):

TYPE OF ENTITY:

EFFECTIVE DATE: New plan. The Participating Employer is adopting this Plan as a new Plan effective

Restated plan. The Participating Employer is adopting this Plan as a restatement of [insert name of Participating Employer’s plan(s) being restated].

(a) This restatement is effective

(b) The original effective date of the plan(s) being restated is:

ALLOCATION OF CONTRIBUTIONS. Any contributions made under this Plan (and any forfeitures relating to such contributions) will be allocated to all Participants of the Employer (including the Participating Employer identified on this Participating Employer Adoption Page). To override this default provision, check below.

Check this box if contributions made by the Participating Employer signing this Participating Employer Adoption Page (and any forfeitures relating to such contributions) will be allocated only to Participants actually employed by the Participating Employer making the contribution. If this box is checked, Employees of the Participating Employer signing this Participating Employer Adoption Page will not share in an allocation of contributions (or forfeitures relating to such contributions) made by the Employer or any other Participating Employer. [Note: The selection of this box may require additional testing of the Plan. See Section 16.04 of the Plan.]

MODIFICATIONS TO ADOPTION AGREEMENT. The selections in the Adoption Agreement (including any special effective dates identified in Appendix A) will apply to the Participating Employer executing this Participating Employer Adoption Page., unless modified under this section.

(a) Special Effective Dates. Check this (a) if different special effective dates apply with respect to the Participating Employer signing this Participating Employer Adoption Page. Attach a separate Addendum to the Adoption Agreement entitled “Special Effective Dates for Participating Employer” and identify the special effective dates as they apply to such Participating Employer.

(b) Modification of Adoption Agreement elections. Page(s) ________ of the Agreement are being modified for this Participating Employer. The modified provisions are effective ___________________________________. [Note: Attach the modified pages as an addendum to this Participating Employer Adoption Page.]

SIGNATURE. By signing this Participating Employer Adoption Page, the Participating Employer agrees to adopt (or to continue its participation in) the Plan identified on page 1 of this Agreement. The Participating Employer agrees to be bound by all provision of the Plan and Adoption Agreement as completed by the signatory Employer, unless specifically provided otherwise on this Participating Employer Adoption Page. The Participating Employer also agrees to be bound by any future amendments (including any amendments to terminate the Plan) as adopted by the signatory Employer.

(Name of Participating Employer)

(Name of authorized representative) (Title)

(Signature) (Date)

Sample Document

[Plan Name] Appendix A – Special Effective Dates

© 2006 ASC Institute Page A-1

APPENDIX A SPECIAL EFFECTIVE DATES

A-1 Eligible Employees. The definition of Eligible Employee under AA §3 is effective as follows:

A-2 Minimum age and service conditions. The minimum age and service conditions Entry Date provisions specified in AA §4 are effective as follows:

A-3 Compensation definitions. The compensation definitions under AA §5 are effective as follows:

A-4 Employer Contributions. The Employer Contribution provisions under AA §6 are effective as follows:

A-5 Salary Deferrals. The provisions regarding Salary Deferrals under AA §6A are effective as follows:

A-6 Matching Contributions. The Matching Contribution provisions under AA §6B are effective as follows:

A-7 Safe Harbor Plan provisions. The Safe Harbor Plan provisions under AA §6C effective as follows:

A-8 After-Tax Contributions. The After-Tax Contribution provisions under AA §6D are effective as follows:

A-9 Retirement age. The retirement age provisions under AA §7 are effective as follows:

A-10 Vesting and forfeiture rules. The rules regarding vesting and forfeitures under AA §8 are effective as follows:

A-11 Distribution provisions. The distribution provisions under AA §9 are effective as follows:

A-12 In-service distributions and Required Minimum Distributions. The provisions regarding in-service distribution and Required Minimum Distributions under AA §10 are effective as follows:

A-13 Miscellaneous provisions. The provisions under AA §11 are effective as follows:

A-14 Special effective date provisions for merged plans. If any qualified retirement plans have been merged into this Plan, the provisions of Section 14.03 of the Plan apply, except as follows:

A-15 Other special effective dates:

Sample Document

[Plan Name] Appendix B – Loan Policy

© 2006 ASC Institute Page B-1

APPENDIX B LOAN POLICY

B-1 Are PARTICIPANT LOANS permitted? (See Section 13 of the Plan.) (a) Yes. (b) No.

B-2 LOAN PROCEDURES. (a) Loans will be provided under the default loan procedures set forth in Section 13 of the Plan, unless

modified under this Appendix B. (b) Loans will be provided under a separate written loan policy. [If this (b) is checked, do not complete the

remainder of this Appendix B.]

B-3 LOAN LIMITS. The default loan policy under Section 13.03 of the Plan allows Participants to take a loan provided all outstanding loans do not exceed 50% of the Participant’s vested Account Balance. To override the default loan policy to allow loans up to $10,000, even if greater than 50% of the Participant’s vested Account Balance, check box below.

A Participant may take a loan equal to the greater of $10,000 or 50% of the Participant's vested Account Balance. [If this AA §B-3 is checked, the Participant may be required to provide adequate security as required under Section 13.06 of the Plan.]

B-4 NUMBER OF LOANS. The default loan policy under Section 13.04 of the Plan restricts Participants to one loan outstanding at any time. To override the default loan policy and permit Participants to have more than one loan outstanding at any time, complete (a) or (b) below.

(a) A Participant may have _______ loans outstanding at any time.

(b) There are no restrictions on the number of loans a Participant may have outstanding at any time.

B-5 INTEREST RATE. The default loan policy under Section 13.05 of the Plan provides for an interest rate commensurate with the interest rates charged by local commercial banks for similar loans. To override the default loan policy and provide a specific interest rate to be charged on Participant loans, complete this AA §B-5.

(a) The prime interest rate (1) plus _______ percentage point(s).

(b) Describe:

B-6 MINIMUM LOAN AMOUNT. The default loan policy under Section 13.04 of the Plan provides that a Participant may not receive a loan of less than $1,000. To modify the minimum loan amount, complete (a) or (b) below.

(a) There is no minimum loan amount.

(b) The minimum loan amount is $____________.

B-7 PURPOSE OF LOAN. The default loan policy under Section 13.02 of the Plan provides that a Participant may receive a Participant loan for any purpose. To modify the default loan policy to restrict the availability of Participant loans, complete (a) or (b) below.

(a) A Participant may only receive a Participant loan upon the demonstration of a hardship event, as described in Section 8.10(d)(1)(i) of the Plan.

(b) A Participant may only receive a Participant loan under the following circumstances:

B-8 SOURCE OF LOAN. The default loan policy under Section 13.09 of the Plan provides that Participant loans will be made first from Employer Contribution and Employer Matching Contributions Accounts and then from the Salary Deferral Account(s). To modify the default loan policy to modify the contribution sources from which a Participant loan is made, complete (a) or (b) below.

(a) Participant loans will be made on a prorata basis from all contribution sources. (b) Participant loans will only be available from the following contribution sources:

Sample Document

[Plan Name] Appendix C – Administrative Elections

© 2006 ASC Institute Page C-1

APPENDIX C ADMINISTRATIVE ELECTIONS

Use this Appendix C to identify certain elections dealing with the administration of the Plan. These elections may be changed without reexecuting this Agreement by substituting an updated Appendix C with new elections.

C-1 DIRECTION OF INVESTMENTS. Are Participants permitted to direct investments? (See Section 10.08(c) of the Plan.)

(a) No (b) Yes

(1) Specify Accounts: (2) Check this selection if the Plan is intended to comply with ERISA §404(c). (See Section 10.08(d)

of the Plan.)

C-2 ROLLOVER CONTRIBUTIONS. Does the Plan accept Rollover Contributions? (See Section 3.07 of the Plan.) (a) No (b) Yes

C-3 QDRO PROCEDURES. Do the default QDRO procedures under Section 11.06 of the Plan apply? (a) No (b) Yes

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